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1.
目的:探讨关节镜清理术治疗膝骨关节炎的护理措施。方法:选取采用关节镜下清理术治疗的膝骨关节炎患者68例,对其术前和术后进行系统的护理、心理指导、病情观察、康复锻炼指导。结果:68例患者关节镜手术顺利,平均住院(7.0±0.8)d,术后膝关节功能恢复良好。8例发生膝关节积液,无感染及静脉血栓等其他并发症。结论:关节镜下清理术治疗膝骨关节炎,做好术前和术后精心护理,能避免手术并发症,是膝关节功能恢复和手术成功的重要保证。  相似文献   

2.
目的观察关节镜下治疗膝关节骨性关节炎的临床疗效。方法回顾性观察膝关节镜下清理术治疗早中期膝关节骨性关节炎和广泛清理术结合钻孔微骨折术治疗晚期膝关节骨性关节炎的疗效。结果24个月内,早中期组Lysholm功能评分由术前(41.37±3.46)分提高到(80.3±7.94)分。晚期组Lysholm功能评分由(36.58±4.27)分提高到(75.6±6.36)分。结论对早中期骨性关节炎采用关节镜下有限清理,对晚期骨性关节炎采用关节镜下广泛清理加软骨微骨折术,辅以积极康复治疗,均可取得良好疗效。  相似文献   

3.
关节镜清理术治疗老年性膝骨关节炎   总被引:1,自引:0,他引:1  
目的探讨关节镜对老年性膝骨关节炎的诊断价值及治疗效果。方法自2001年10月至2003年3月使用关节镜清理治疗膝关节骨关节炎患者37例,按照Lysholm膝关节功能评分,术前膝关节功能评分为(53.6±7.3)分。随访3~15个月,平均9个月。结果本组37例病人经关节镜检查均证实有骨关节炎存在,术前摄片,21例出现病理改变,16例未发现病理改变。本组病人术后3个月症状缓解明显,Lysholm膝关节功能评分平均提高到(92.7±1.5)分,统计学分析显示术后与术前评分相比差异有显著性意义。结论关节镜清理术可有效治疗膝骨关节炎;膝关节镜术可早期诊断膝骨关节炎;其损伤小、疗效好、并发症少,可重复手术治疗,能早期恢复关节的功能。  相似文献   

4.
目的 探讨采用胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎的疗效。方法 对22例膝内侧单间室骨关节炎患者先行关节镜下清理术,再予以胫骨内侧高位截骨。采用Lysholm评分评价疗效。结果 患者均获得1年随访。切口均一期愈合,术后8周胫骨截骨处基本愈合。术后半年及1年均采用Lysholm膝关节功能评分评价疗效:术后半年优19例,良2例,可1例,优良率21/22;术后1年优18例,良2例,可2例,优良率20/22。结论 胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎可以有效改善患者膝关节症状,是一种简单、安全的手术方法。  相似文献   

5.
目的探讨关节镜下关节有限清理术治疗早中期膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法 2004年4月~2013年10月,对45例早中期KOA在关节镜下进行刨削清理增生肥厚的炎性滑膜组织,修平退变剥脱的软骨创面,游离体摘除,去除影响关节活动的骨赘,半月板修整或成形等,术后关节腔内注入玻璃酸钠4 ml。治疗前后采用膝关节Lysholm评分进行疗效评估。结果关节镜手术时间(从关节镜进入膝关节到开始缝合切口)为(55±15)min。术后住院时间4~10 d,平均6 d。术后均无关节感染、血管神经损伤、深静脉栓塞等并发症的发生。45例随访时间3~26个月,平均12个月,Lysholm评分由术前(45.5±6.3)分提高到(78.7±8.3)分,手术前后有统计学差异(t=9.841,P=0.005)。结论关节镜下关节有限清理术联合玻璃酸钠具有创伤小,并发症少,有效缓解KOA症状,有效改善关节功能的优点,是治疗早中期KOA的有效方法。  相似文献   

6.
目的探讨膝关节骨性关节炎患者行关节镜下清理术中射频汽化的治疗作用。方法 2003年6月~2004年6月在我院行关节镜下清理术应用射频汽化治疗的40例膝骨关节炎为实验组,同期40例关节镜下清理术未应用射频汽化治疗为对照组。手术前、后采用Lysholm评分进行膝关节功能评定。结果实验组术前Lysholm评分为(53.6±6.4)分,术后提高至(83.4±4.7)分(t=21.549,P=0.000)。对照组术前Lysholm评分为(55.5±5.1)分,术后提高至(79.8±6.1)分(t=20.697,P=0.000)。实验组术后Lysholm评分总分(83.4±4.7)分和疼痛项评分(18.6±3.9)分明显高于对照组(79.8±6.1)分和(16.6±3.8)分(t=2.957,P=0.004;t=2.323,P=0.023),但2组术后力量项评分无显著差异[(6.3±1.6)分vs(6.2±1.5)分,t=0.288,P=0.774]。结论关节镜下清理术中应用射频汽化可明显改善膝关节骨性关节炎患者术后关节功能和减轻疼痛。  相似文献   

7.
目的:探讨关节镜结合中药热敷治疗早中期膝骨关节炎(KOA)的疗效。方法:将100例KOA患者,分为两组,治疗组予局麻下行关节镜清理术,结合中药热敷等治疗,对照组予中药热敷及抗炎镇痛药物治疗,观察两组的临床疗效及膝关节功能Lysholm评分。结果:治疗组总有效率91%,对照组为80%,(P〈0.05),治疗组Lysholm评分为(89.95±0.87)分,对照组为(76.37±1.28)分,(P〈0.05)。结论:局麻下关节镜清理术结合中药热敷治疗早中期膝骨关节炎,疗效较单独中药热敷更显著。  相似文献   

8.
关节镜下有限与广泛清理术治疗膝骨性关节炎的临床比较   总被引:20,自引:5,他引:15  
目的 :评价和比较关节镜下有限和广泛清理术对膝关节骨关节炎的疗效。方法 :将本院 1999~ 2 0 0 1年间治疗的 2 42例膝骨关节炎的患者分为两组 :A组 10 0例 ,119侧膝 ,行有限清理术 ,B组 10 0例 ,12 3侧膝 ,行广泛清理术。随访 3 0~ 48个月。结果 :采用吴海山综合评分体系对膝关节OA术前术后进行评分比较 ,不同术式的 2组总有效率分别为 75 %以及 74% (P >0 0 5 ) ,两组术前膝关节综合评分A组为 11 2± 4 2 ,B组为 12 1± 5 3 (P >0 0 5 ) ,术后 1年综合评分A组为 6 5± 2 1,B组为 7 0± 2 5 ,两组差异无统计学意义 (P >0 0 5 )。两组疗效维持时间A组 3 6± 1 4年 ,B组 3 3± 1 7年 ,两组差异无统计学意义 (P >0 0 5 )。有限清理术的手术时间平均 15min ,广泛清理术平均手术时间 40min ,术后平均恢复期分别为 3和 10d。结论 :对于膝骨关节炎的疗效 ,关节镜术下有限和广泛清理术是相似的 ,且疗效维持时间无差别。但有限清理术手术时间短且创伤较小、恢复快  相似文献   

9.
目的比较腓骨近端截骨术联合关节镜清理与单髁关节置换术(UKA)治疗膝关节内侧间室骨关节炎的疗效。方法选取2014年1月至2015年1月在本院接受手术治疗的膝关节内侧间室骨关节炎患者36例(36膝),依患者自主意愿选择手术方式后分为2组:截骨术组(17例)行腓骨近端截骨术联合关节镜清理,UKA组(19例)行UKA。术后1、3、6、12个月返院随访,采用Lysholm评分、牛津膝关节评分(OKS)、膝关节损伤和骨关节炎结果评分(KOOS)评估关节活动度和关节功能,影像学随访评价假体情况、骨溶解及感染等并发症。结果两组患者年龄、性别、体质量指数、关节炎分级(均为Ⅲ~Ⅳ级)等无差别。UKA组手术时间和住院时间长于截骨术组,术中出血量及术后引流量多于截骨术组(P0.05)。36例患者均得到随访,平均随访时间12.5个月。两组患者末次随访时Lysholm评分、OKS评分、KOOS评分均较术前明显改善(P0.05)。两组患者Lysholm评分、OKS评分、KOOS评分与术前比较的改善程度无差异(P0.05)。结论腓骨近端截骨术联合关节镜清理与UKA治疗膝关节内侧间室骨关节炎的近期疗效无差异,腓骨近端截骨术联合关节镜清理是一种值得推广的术式。  相似文献   

10.
尹毅  赵燕 《中国骨伤》2014,27(4):287-290
目的:探讨电针在膝骨性关节炎关节镜清理术后的增效作用.方法:2008年5月至2010年7月,收治膝骨性关节炎患者78例(78膝),分为两组,其中试验组42例,男16例,女26例;年龄41~63岁,平均(53.62±6.53)岁;病程8 ~24个月,平均(10.35±6.42)个月;采用关节镜下有限清理术结合术后电针治疗.对照组36例,男14例,女22例;年龄40~62岁,平均(54.34±7.67)岁;病程6~25个月,平均(11.94±5.13)个月;采用单一关节镜下关节清理术治疗.两组患者术后均行股四头肌等长收缩和膝关节屈伸功能锻炼.以视觉模拟评分法(visual analog scale,VAS)和Lysholm膝关节功能评分标准进行治疗前后及组间比较.结果:所有患者获随访,时间12~30个月,平均15.6个月.末次随访时试验组和对照组VAS较术前降低,而Lysholm评分除支撑外,其余各项评分均较疗前升高.两组治疗后VAS比较差异有统计学意义;Lysholm评分在跛行、疼痛、肿胀、爬楼及下蹲方面差异有统计学意义,而交锁和不稳评分差异无统计学意义.结论:电针具有明显缓解临床症状、体征,改善膝关节活动度的作用,在膝骨性关节炎关节镜清理术后具有显著增效作用,其远期疗效优于单用关节镜清理术,对膝关节的功能改善更具优越性,是值得临床推荐的一种治疗膝骨性关节炎的中西医结合疗法.  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

14.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

15.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

16.
Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.  相似文献   

17.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

18.
19.
Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

20.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

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